Is There Sufficient Evidence for Continuous Local Anesthetic Wound Infusions as Postoperative Standard of Care in Patients With Head and Neck Cancer?

Nimotuzumab, humanized monoclonal antibody, directed against the epidermal growth factor receptor: highly expressed protein in malignant tumors of epithelial origin. It has been registered for head and neck tumors since 2002. To determine the effectiveness of Nimotuzumab in head and neck cancer through the combined meta-analysis technique. A search was conducted in PubMed, in an indexed magazine with the words “Nimotuzumab”, “head and neck,” 48 articles published by Cuban and foreign authors were detected between April 1, 2005, and July 31, 2019, in which the results of clinical studies conducted with the monoclonal antibody Nimotuzumab are described. Seven clinical trials conducted in Cuba from 2005-2019 with Nimotuzumab are described; three Phase I / II (with 14, 10 and 10 patients respectively), a Phase II / III with 106 patients, a Phase II with 37 patients, two Phase IV (with 386 and 225 patients each) and a study promoted by the Researcher with 17 patients. From these studies, the three controlled trials were selected by the PRISMA flow chart. The meta-analysis consisted of the construction of the Forest Plot graph, the sensitivity analysis and the cumulative analysis. The meta-analysis shows favorable results for Nimotuzumab, without heterogeneity (I2 = 0%). The sensitivity analysis reveals that the test that differs most from the others is Phase II / III. The cumulative analysis indicates that after the second trial, there is already sufficient evidence.

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Treatment of head and neck cancer with photodynamic therapy: results after one year

The Journal of Laryngology & Otology ◽

10.1017/s0022215100132050 ◽

1995 ◽

Vol 109 (11) ◽

pp. 1072-1076 ◽

Cited By ~ 10

Author(s):

M. G. Dtlkes ◽

M. L. DeJode ◽

Q. Gardiner ◽

G. S. Kenyon ◽

P. McKelvie

Keyword(s):

Head And Neck Cancer ◽

Photodynamic Therapy ◽

Head And Neck ◽

Neck Cancer ◽

First Generation ◽

Sufficient Evidence ◽

Clinical Responses ◽

Promising Treatment ◽

One Year ◽

Multicentre Prospective Study

AbstractPhotodynamic therapy (PDT) is a new and promising treatment modality for the treatment of malignant disease. This paper reports the preliminary experience of our group in the use of this therapy for the treatment of tumours arising in the head and neck. The majority of treatments in these cases have used a second generation systemic photosensitizer, meta-tetrahydroxyphenylchlorin (m-THPC). Two other cases were treated with either Photofrin 2 (a first generation systemic sensitizer) or with the topical photosensitizer, delta-aminolaevulinic acid (δ-ALA).The initial results have been encouraging with good clinical responses evident in patients presenting with a variety of differing tumour types. We feel there is now sufficient evidence of the efficacy of this treatment to warrant a multicentre prospective study into the treatment of early head and neck cancer with PDT.

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Protocol for the trismus trial—therabite versus wooden spatula in the amelioration of trismus in patients with head and neck cancer: randomised pilot study

BMJ Open ◽

10.1136/bmjopen-2018-021938 ◽

2018 ◽

Vol 8 (3) ◽

pp. e021938

Author(s):

Rana Lee ◽

Alex Molassiotis ◽

Simon N Rogers ◽

Rhiannon Tudor Edwards ◽

David Ryder ◽

...

Keyword(s):

Head And Neck Cancer ◽

Head And Neck ◽

Neck Cancer ◽

Objective Assessment ◽

Mouth Opening ◽

Standard Of Care ◽

Good Clinical Practice ◽

Open Label ◽

North West ◽

Primary Surgery

IntroductionPatients can develop trismus from their head and neck cancer or as a result of treatment. Trismus affects the jaw muscles and makes mouth opening difficult. To potentially combat trismus, patients could undertake proactive jaw stretching exercises prior to, during and after radiotherapy, although currently these are not the standard of care.Methods and analysisThis is a randomised, open-label, controlled, two-centre feasibility study, to assess the objective and subjective effectiveness and cost-effectiveness of therabite use compared with wooden spatula in ameliorating trismus in patients treated for stage 3 and 4 oral and oropharyngeal cancer, managed either by primary surgery followed by (chemo)radiotherapy or primary (chemo)radiotherapy. The principal objective assessment is measurement of maximum jaw opening. Assessments in all cases will be performed preradiotherapy and again at 3 and 6 months postintervention.Secondary aims of the study will be (1) to assess whether therabite or the wooden spatula intervention improves patients’ quality of life, (2) reduce the level of post-treatment clinical management/healthcare use and (3) a nested qualitative study will explore the experience of the patient taking part in the intervention; data will be transcribed verbatim and analysis will be based on content analysis methods using the interview questions as the framework for examination.Ethics and disseminationNorth West Greater Manchester granted ethical approval (REC Reference 11/NW/0744). Good Clinical Practice and the Declaration of Helsinki have been adhered to. The results will be presented internationally and submitted to a peer-reviewed journal. Head and neck cancer charities and information websites will also be approached.Trial registration numberNCT01733797.

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Special Issue about Head and Neck Cancers: HPV Positive Cancers

International Journal of Molecular Sciences ◽

10.3390/ijms21093388 ◽

2020 ◽

Vol 21 (9) ◽

pp. 3388 ◽

Cited By ~ 3

Author(s):

Panagiota Economopoulou ◽

Ioannis Kotsantis ◽

Amanda Psyrri

Keyword(s):

Head And Neck Cancer ◽

Head And Neck ◽

Neck Cancer ◽

Economic Status ◽

Locally Advanced ◽

Standard Of Care ◽

Papilloma Virus ◽

High Risk Sexual Behavior ◽

Hpv Status ◽

Delays In Diagnosis

The oropharynx has become the leading primary site for Human Papilloma Virus (HPV)-associated head and neck cancer. HPV positive oropharyngeal squamous cell carcinoma (HPV+ OSCC) has emerged as an epidemic not easily recognized by many physicians, resulting in delays in diagnosis and management. HPV+ OSCC traditionally refers to younger, healthier patients with high economic status and high-risk sexual behavior and is related to improved prognosis. De-intensification strategies are being evaluated in ongoing clinical trials and if validated, might help spare severe morbidity associated with current cisplatin-based chemoradiotherapy, which is the standard of care for all patients with locally advanced head and neck cancer. On the other hand, whether HPV status represents an important prognostic factor for non-oropharyngeal sites remains to be elucidated.

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Head and Neck Cancer in 1994: a Change in the Standard of Care

JNCI Journal of the National Cancer Institute ◽

10.1093/jnci/86.4.250 ◽

1994 ◽

Vol 86 (4) ◽

pp. 250-252 ◽

Cited By ~ 18

Author(s):

C. Jacobs

Keyword(s):

Head And Neck Cancer ◽

Head And Neck ◽

Neck Cancer ◽

Standard Of Care

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489 Assessing the Impact Of COVID-19 On Head and Neck Cancer Treatment and Preparing for The Next Wave

British Journal of Surgery ◽

10.1093/bjs/znab259.465 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

K Daga ◽

L Argus ◽

J Goswami

Keyword(s):

Head And Neck Cancer ◽

Head And Neck ◽

Neck Cancer ◽

Elective Surgery ◽

Standard Of Care ◽

Tnm Staging ◽

World Health ◽

Number Of Patients ◽

Novel Coronavirus ◽

The Impact

Abstract Introduction As of 11th of March 2020, the World Health Organization (WHO) declared the novel coronavirus 2019 (COVID-19) a pandemic. It is estimated that urgent cancer referrals have reduced 70-89% across hospitals in England during the COVID-19 pandemic, in addition to reductions in attendance for the different treatment arms. The aim of our investigation is to assess the impact of COVID-19 on MDT outcomes and patients attending/receiving treatment as compared to before for head and neck cancer. Method Data was collected retrospectively over a period of 203 days (7th January to 28th July 2020), including 66 patients prior to COVID-19 being declared a pandemic and 116 patients since, at a regional cancer centre. A total of 182 patients undergoing treatment were identified. These patients were assessed by TNM staging, MDT outcomes and final initial treatment intents, which were compared to pre-COVID outcomes. Results With respect to MDT outcomes, there was an increase in the number of patients decided for surgery from 10.61% to 23.28% (p = 0.78) during the first wave of the pandemic. Patients decided for radiotherapy and chemotherapy increased by 12.49% and 4.31% respectively. Notably, there was a decrease in further investigations and referrals from 37.88% to 18.10%. Moreover, an increase in palliative treatment intent by 10.55% was noted during the pandemic. Conclusions As the UK enters into the next peak of the pandemic, with reduced capacity for elective surgery and outpatient clinics, it is essential to consider its impact on the standard of care delivered to current cancer patients.

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Combining Systemic Therapy With Radiation: Head and Neck Cancer Treatments in an Era of Targeted Agents and Immunotherapy

Journal of the National Comprehensive Cancer Network ◽

10.6004/jnccn.2020.7594 ◽

2020 ◽

Vol 18 (7) ◽

pp. 907-913

Author(s):

Harish N. Vasudevan ◽

Sue S. Yom

Keyword(s):

Head And Neck Cancer ◽

Head And Neck ◽

Neck Cancer ◽

Systemic Therapy ◽

Standard Of Care ◽

Cytotoxic Agents ◽

Concurrent Chemoradiation ◽

Significant Toxicity ◽

Dosing Regimens ◽

Treatment Paradigm

The addition of chemotherapy to radiation therapy (RT) has been established for decades to improve outcomes in patients with head and neck cancer (HNC). Concurrent chemoradiation increases both local control and overall survival but at the cost of significant toxicity, motivating extensive investigations to optimize the balance of clinical efficacy and adverse effects. This review discusses the rationale and seminal studies underlying the concurrent chemoradiation treatment paradigm in HNC, and describes attempts to better tailor systemic therapy beyond standard-of-care cisplatin, such as the use of alternate cytotoxic agents and nonstandard dosing regimens. Modern efforts to incorporate targeted therapies and immunotherapy are then summarized, particularly for patients unable to receive standard cytotoxic chemotherapy. Finally, mechanisms through which RT and systemic therapy cooperate to improve the therapeutic ratio are discussed, with a focus on the interaction between immunotherapy and RT, a rapidly emerging treatment paradigm. With increasing application of novel diagnostic and therapeutic approaches, determining the optimal concurrent systemic program to maximize RT efficacy will continue to evolve. Identification of patient- and tumor-specific factors will offer a unique opportunity to implement personalized oncologic care.

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